Schizophreniform Disorder
DSM-II In DSM-II, this disorder is called Acute schizophrenic episode For more information, see Schizophrenia This diagnosis does not apply to acute episodes of schizophrenic disorders described elsewhere. This condition is distinguished by the acute onset of schizophrenic symptoms, often associated with confusion, perplexity, ideas of reference, emotional turmoil, dreamlike dissociation, and excitement, depression, or fear. The acute onset distinguishes this condition from simple schizophrenia. In time these patients may take on the characteristics of catatonic, hebephrenic or paranoid schizophrenia, in which case their diagnosis should be changed accordingly. In many cases the patient recovers within weeks, but sometimes his disorganization becomes progressive. More frequently remission is followed by recurrence. DSM-III Diagnostic Criteria A'''. Meets all of the criteria for Schizophrenia except for duration. '''B. The illness (including prodromal, active, and residual phases) lasts more than two weeks but less than six months. Differential Diagnosis Schizophrenia Since the diagnostic criteria for Schizophrenia and Schizophreniform Disorder differ only in duration of illness, most of the discussion of differential diagnosis in the text for Schizophrenia applies equally to Schizophreniform Disorder, with the exception that the clinical picture in Schizophreniform Disorder is more often characterized by emotional turmoil, fear, confusion, and particularly vivid hallucinations. Brief Reactive Psychosis Brief Reactive Psychosis differs from Schizophreniform Disorder in that the duration of the disturbance is less than two weeks (although secondary effects may persist longer). In addition, Brief Reactive Psychosis always follows a psychosocial stressor, which frequently is not present before the onset of Schizophreniform Disorder. If what appears to be a Brief Reactive Psychosis persists beyond two weeks, a diagnosis of Schizophreniform Disorder should be considered. Atypical Psychosis Atypical Psychosis should be diagnosed if the symptom picture is consistent with that of Schizophreniform Disorder but the duration is less than two weeks and the disturbance does not follow a psychosocial stressor. DSM-IV Diagnostic Criteria A'''. Criteria A, D, and E of Schizophrenia are met. '''B. An episode of the disorder (including prodromal, active, and residual phases) lasts at least 1 month but less than 6 months. (When the diagnosis must be made without waiting for recovery, it should be qualified as "Provisional.") Specify if: # Without Good Prognostic Features # With Good Prognostic Features: as evidenced by two (or more) of the following: ## onset of prominent psychotic symptoms within 4 weeks of the first noticeable change in usual behavior or functioning ## confusion or perplexity at the hieght of the psychotic episode ## good premorbid social and occupational functioning ## absence of blunted or flat affect Specifiers The following specifiers for Schizophreniform Disorder may be used to indicate the presence of absence of features that may be associated with a better prognosis: With Good Prognostic Features This specifier is used if at least two of the following features are present: onset of prominent psychotic symptoms within 4 weeks of the first noticeable change in usual behavior or functioning, confusion or perplexity at the height of the psychotic episode, good premorbid social and occupational functioning, and absence of blunted or flat affect. Without Good Prognostic Features This specifier is used if two or more of the above features have not been present. Differential Diagnosis Because the diagnostic criteria for Schizophrenia and Schizophreniform Disorder differ primarily in terms of duration of illness, the discussion of the differential diagnosis of Schizophrenia also applies to Schizophreniform Disorder. Schizophreniform Disorder differs from Brief Psychotic Disorder, which has a duration of less than 1 month. DSM-5 Diagnostic Criteria A'''. Two (or more) of the following, each present for a significant portion of time during a 1-month period (or less if successfully treated). At least one of these must be (1), (2), or (3): # Delusions. # Hallucinations. # Disorganized speech (e.g, frequent derailment or incoherence). # Grossly disorganized catatonic behavior. # Negative symptoms (i.e., diminished emotion expression or avolition '''B. An episode of the disorder lasts at least 1 month but less than 6 months. When the diagnosis must be made without waiting for recovery, it should be qualified as "provisional." C'''. Schizoaffective disorder and depressive or bipolar disorder with psychotic features have been ruled out because either 1) no major depressive or manic episodes have occurred concurrently with the active-phase symptoms, or 2) if mood episodes have occurred during active-phase symptoms, they have been present for a minority of the total duration of the active and residual periods of the illness. '''D. The disturbance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition. Specify if: * With good prognostic features: This specifier required the presence of at least two of the following features: onset of prominent psychotic symptoms within 4 weeks of the first noticeable change in usual behavior or functioning; confusion or perplexity; good premorbid social and occupational functioning; and absence of blunted or flat affect. * Without good prognostic features: This specifier is applied if two or more of the above features have not been present. Specify ''if: * '''With catatonia' (Note: Record catatonia associated with schizophreniform disorder to indicate the presence of the comorbid catatonia.) Specify current severity: Severity is rated by a quantitative assessment of the primary symptoms of psychosis, including delusions, hallucinations, disorganized speech, abnormal psychomotor behavior, and negative symptoms. Each of these symptoms may be rated for its current severity (most severe in the last 7 days) on a 5-point scale ranging from 0 (not present) to 4 (present and severe). Note: Diagnosis of schizophreniform disorder can be made without using this severity specifier. Specifiers Catatonia Specifier A'''. The clinical picture is dominated by three (or more) of the following symptoms: # Stupor (i.e., no psychomotor activity; not actively relating to environment). # Catalepsy (i.e., passive induction of a posture held against gravity). # Waxy flexibility (i.e., slight, even resistance to positioning by examiner). # Mutism (i.e., no, or very little, verbal response if known aphasia). # Negativism (i.e., opposition or no response to instructions or external stimuli). # Posturing (i.e., spontaneous and active maintenance of a posture against gravity). # Mannerism (i.e., odd, circumstantial caricature of normal actions). # Stereotypy (i.e., repetitive, abnormally frequent, non-goal-directed movements). # Agitation, not influenced by external stimuli. # Grimacing. # Echolalia (i.e., mimicking another's speech). # Echopraxia (i.e., mimicking another's movements). '''Differential Diagnosis Since the diagnostic criteria for schizophreniform disorder and schizophrenia differ primarily in duration of illness, the discussion of the differential diagnosis of schizophrenia also applies to schizopreniform disorder. Other mental disorders and medical conditions A wide variety of mental and medical conditions can manifest with psychotic symptoms that must be considered in the differential diagnosis of schizophreniform disorder. These include psychotic disorder due to another medical condition or its treatment; delirium or major neurocognitive disorder; substance/medication-induced psychotic disorder or delirium; depressive or bipolar disorder with psychotic features; schizoaffective disorder; other specified or unspecified bipolar and related disorder; depressive or bipolar disorder with catatonic features; schizophrenia; brief psychotic disorder; delusional disorder; other specified or unspecified schizophrenia spectrum and other psychotic disorder; schizotypal, schizoid, or paranoid personality disorders; autism spectrum disorder; disorders presenting in childhood with disorganized speech; attention-deficit/hyperactivity disorder; obsessive-compulsive disorder; posttraumatic stress disorder; and traumatic brain injury. Brief psychotic disorder Schizophreniform disorder differs in duration from brief psychotic disorder, which has a duration of less than 1 month.